研究动态
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铁过量对糖尿病、心脏病和先天性溶血性贫血死亡的发病率的影响。

Impact of Iron Overload on Incidence of Diabetes Mellitus, Cardiac Disease, and Death in Congenital Hemolytic Anemias.

发表日期:2024 Aug 27
作者: Aaron Cheng, Hanny Al-Samkari
来源: Blood Advances

摘要:

铁超负荷及其并发症被认为对于先天性溶血性贫血患者来说是病态和致命的。在先天性溶血性贫血引起的铁超负荷患者中,尚无研究评估铁超负荷血清标志物与长期健康并发症之间的剂量-反应关系。填补这一关键空白是本研究的目的。我们评估了一项 5 家医院观察性队列研究的结果,该研究的对象是患有先天性溶血性贫血且被诊断为铁过载的成人,历时 40 年,并评估了铁过载的深度和持续时间与临床并发症(包括糖尿病、心脏病、恶性肿瘤、骨密度紊乱和死亡。 170 名患有先天性溶血性贫血并出现铁超负荷的患者被纳入研究。铁蛋白超过 500 ng/mL 和超过 1000 ng/mL 的年数与糖尿病的发生相关,调整后的比值比为每 10 年增量 2.61,p=0.034 和每 10 年增量 3.24,p=0.035 , 分别。铁蛋白 >1000 ng/mL 的年数越长,与心脏病的发生相关(每 10 年增量调整 OR 5.30,p=0.002)。终生铁蛋白峰值 >10000 ng/mL 与 6 倍的糖尿病发病率 (p=0.04) 和 10 倍的心脏病发病率 (p=0.007) 相关。铁蛋白峰值 >10,000 ng/mL 与死亡率增加相关(调整后 OR 6.77,p=0.033)。总之,先天性溶血性贫血患者的铁超负荷与糖尿病、心脏病和死亡相关。长期处于相对适度的铁超负荷状态与糖尿病发病率增加近 3 倍有关。版权所有 © 2024 美国血液学会。
Iron overload and its complications are recognized to be morbid and fatal in patients with congenital hemolytic anemias. In patients with iron overload caused by congenital hemolytic anemias, there has been no study evaluating the dose-response relationship between serum markers of iron overload and long-term health complications. Filling this critical gap was the aim of the present study. We evaluated outcomes in a 5-hospital observational cohort study of adults with congenital hemolytic anemias diagnosed with iron overload over a 40-year period, and assessed associations between depth and duration of iron overload, and clinical complications including diabetes, heart disease, malignancy, bone density disorders, and death. 170 patients with congenital hemolytic anemias developing iron overload were included. More years experienced of ferritin over 500 ng/mL and over 1000 ng/mL were associated with the development of diabetes mellitus with adjusted odds ratios of 2.61 per 10-year increment, p=0.034 and 3.24 per 10-year increment, p=0.035, respectively. More years experienced of ferritin >1000 ng/mL were associated with development of heart disease (adjusted OR 5.30 per 10-year increment, p=0.002). Peak lifetime ferritin of >10000 ng/mL was associated with 6-fold odds of developing diabetes (p=0.04) and a 10-fold odds of developing heart disease (p=0.007). A peak ferritin >10,000 ng/mL was associated with an increase in mortality (adjusted OR 6.77, p=0.033). In conclusion, iron overload in patients with congenital hemolytic anemias is associated with diabetes mellitus, cardiac disease, and death. Prolonged exposure to relatively modest iron overload was associated with nearly 3-fold increased odds of diabetes.Copyright © 2024 American Society of Hematology.